Disclaimer

  • References: Iraq Centre for Disease control (CDC), see XXX.

  • 🇮🇶 Iraq Ministry of Health:

Iraq Ministry of Health

Iraq Ministry of Health
  • For more information:, go to XXX.

CCHF in Iraq – data from 2022–2023

CCHF Situation Summary, Iraq 2022-2023

🇮🇶 National Summary: Confirmed Cases, Deaths, and CFR
Year Deaths Cases CFR (%)
2022 71.00 353.00 20.1%
2023 81.00 562.00 14.4%
Overall 152.00 915.00 16.6%
  • 915 cases in 2022-2023
  • 152 deaths in 2022-2023
  • In 2023, Erbil reported the highest case fatality rate at 42.9%.
  • In 2022, Salah Al-Din reported the highest case fatality rate at 100.0%.
  • Majority in central and southern governorates
  • Seasonal pattern with peak around April–July
CCHF Case Summary:🇮🇶 Iraq (2023)
Governorate Confirmed Cases Deaths Case Fatality Rate (%)
Thi-Qar 136.0 15.0 11.0
Diwaniya 23.0 4.0 17.4
Kerbala 11.0 3.0 27.3
Basrah 84.0 13.0 15.5
Baghdad-Resafa 55.0 11.0 20.0
Babylon 22.0 3.0 13.6
Baghdad-Karkh 33.0 4.0 12.1
Wassit 36.0 2.0 5.6
Najaf 17.0 2.0 11.8
Missan 38.0 3.0 7.9
Diyala 16.0 3.0 18.8
Muthanna 34.0 4.0 11.8
Salah Al-Din 6.0 1.0 16.7
Anbar 1.0 0.0 0.0
Erbil 14.0 6.0 42.9
Kirkuk 14.0 2.0 14.3
Dahuk 5.0 0.0 0.0
Ninewa 13.0 4.0 30.8
Sulaymaniyah 4.0 1.0 25.0
Overall 562.0 81.0 14.4

Source: 🇮🇶 Iraq CDC.
  • In 2023, Erbil reported the highest case fatality rate at 42.9%.
  • In 2023, Thi-Qar reported the highest number of cases (136).
CCHF Case Summary:🇮🇶 Iraq (2022)
Governorate Confirmed Cases Deaths Case Fatality Rate (%)
Wassit 26.0 3.0 11.5
Thi-Qar 155.0 39.0 25.2
Diwaniya 16.0 2.0 12.5
Muthanna 16.0 6.0 37.5
Baghdad-Resafa 12.0 3.0 25.0
Babylon 24.0 2.0 8.3
Kerbala 12.0 2.0 16.7
Kirkuk 3.0 1.0 33.3
Ninewa 7.0 0.0 0.0
Missan 35.0 3.0 8.6
Basrah 17.0 1.0 5.9
Najaf 4.0 2.0 50.0
Erbil 3.0 1.0 33.3
Baghdad-Karkh 14.0 2.0 14.3
Anbar 1.0 0.0 0.0
Diyala 4.0 2.0 50.0
Dahuk 2.0 0.0 0.0
Salah Al-Din 2.0 2.0 100.0
Overall 353.0 71.0 20.1

Source: 🇮🇶 Iraq CDC.
  • In 2022, Salah Al-Din reported the highest case fatality rate at 100.0%.
  • In 2022, Thi-Qar reported the highest number of cases (155).

The effect of seasonality on the CCHF incidence

  • In 2022-2023, a total of 3546 suspected CCHF patients attended an hospital in Iraq.
  • CCHF infection was confirmed in 955 suspected cases (27%), 915 by RT-PCR and 40 by serology only .

Case Fatality Rates and Age

Number of CCHF confirmed cases by outcome and month and CFR per year

Ct and CFR

Demographics

Characteristic

Cured
N = 799

1

Death
N = 156

1

p-value

2
Age group – – 0.05
    <15 33/799 (4.1%) 0/156 (0%) –
    age ≥15-<25 202/799 (25%) 30/156 (19%) –
    age ≥25-<35 155/799 (19%) 37/156 (24%) –
    age ≥35-<45 177/799 (22%) 38/156 (24%) –
    age ≥45-<55 133/799 (17%) 32/156 (21%) –
    age ≥55 99/799 (12%) 19/156 (12%) –
Sex – – 0.72
    Female 330/799 (41%) 62/156 (40%) –
    Male 469/799 (59%) 94/156 (60%) –
Age – – 0.03
    Median (Min, Max) 35 (1, 90) 38 (15, 78) –
1

n/N (%)
2

Pearson’s Chi-squared test; Wilcoxon rank sum test

Characteristic

hemorrhagic
N = 340

1

Not hemorrhagic
N = 615

1

p-value

2
Age group – – 0.14
    <15 12/33 (36%) 21/33 (64%) –
    age ≥15-<25 75/232 (32%) 157/232 (68%) –
    age ≥25-<35 67/192 (35%) 125/192 (65%) –
    age ≥35-<45 90/215 (42%) 125/215 (58%) –
    age ≥45-<55 63/165 (38%) 102/165 (62%) –
    age ≥55 33/118 (28%) 85/118 (72%) –
Age – – 0.80
    Median (Min, Max) 35 (1, 90) 35 (1, 80) –
Sex – – 0.15
    Female 150/392 (38%) 242/392 (62%) –
    Male 190/563 (34%) 373/563 (66%) –
Residency status – – 0.72
    Rural 94/263 (36%) 169/263 (64%) –
    Semi-Urban 27/81 (33%) 54/81 (67%) –
    Urban 75/232 (32%) 157/232 (68%) –
Ct – – 0.05
    Median (Min, Max) 27.8 (12.9, 38.3) 26.5 (11.4, 38.9) –
Time from onset to admission – – –
    Median (Min, Max) 4.00 days (-4.00 days, 37.00 days) 3.00 days (-146.00 days, 184.00 days) –
Fever 325/926 (35%) 601/926 (65%) 0.07
Contact with confirmed case 9/33 (27%) 24/33 (73%) 0.34
Contact with animals 197/509 (39%) 312/509 (61%) 0.02
Slaughtering 154/442 (35%) 288/442 (65%) 0.78
Presence of rodents 54/139 (39%) 85/139 (61%) 0.97
Contact with raw meat 197/566 (35%) 369/566 (65%) 0.74
Tick bite 70/176 (40%) 106/176 (60%) 0.18
Echymosis 238/238 (100%) 0/238 (0%) 0.00
Bleeding of injection sites 254/254 (100%) 0/254 (0%) 0.00
Injected eyes 25/42 (60%) 17/42 (40%) 0.00
Ribavirin 59/191 (31%) 132/191 (69%) 0.76
Outcome – – 0.00
    Cured 260/799 (33%) 539/799 (67%) –
    Death 80/156 (51%) 76/156 (49%) –
1

n/N (%)
2

Pearson’s Chi-squared test; Wilcoxon rank sum test

Characteristic

2022
N = 380

1

2023
N = 575

1

p-value

2
Age group – – 0.10
    <15 17/380 (4.5%) 16/575 (2.8%) –
    age ≥15-<25 99/380 (26%) 133/575 (23%) –
    age ≥25-<35 61/380 (16%) 131/575 (23%) –
    age ≥35-<45 85/380 (22%) 130/575 (23%) –
    age ≥45-<55 73/380 (19%) 92/575 (16%) –
    age ≥55 45/380 (12%) 73/575 (13%) –
Age – – 0.91
    Median (Min, Max) 35 (1, 90) 35 (2, 80) –
Sex – – 0.35
    Female 149/380 (39%) 243/575 (42%) –
    Male 231/380 (61%) 332/575 (58%) –
Residency status – – 1.00
    Rural 1/1 (100%) 262/575 (46%) –
    Semi-Urban 0/1 (0%) 81/575 (14%) –
    Urban 0/1 (0%) 232/575 (40%) –
Ct – – 0.00
    Median (Min, Max) 25.8 (11.4, 36.9) 27.4 (12.9, 38.9) –
Time from onset to admission – – –
    Median (Min, Max) 3.00 days (-1.00 days, 13.00 days) 4.00 days (-146.00 days, 184.00 days) –
Fever 359/380 (94%) 567/575 (99%) 0.00
Contact with confirmed case 18/375 (4.8%) 15/567 (2.6%) 0.08
Contact with animals 212/375 (57%) 297/575 (52%) 0.14
Slaughtering 127/375 (34%) 315/574 (55%) 0.00
Presence of rodents 139/289 (48%) -- –
Contact with raw meat 207/375 (55%) 359/573 (63%) 0.02
Tick bite 134/374 (36%) 42/575 (7.3%) 0.00
Hemorrhagic 145/380 (38%) 195/575 (34%) 0.18
Echymosis 104/380 (27%) 134/575 (23%) 0.16
Bleeding of injection sites 109/379 (29%) 145/575 (25%) 0.23
Injected eyes 1/1 (100%) 41/575 (7.1%) 0.07
Ribavirin 1/1 (100%) 190/535 (36%) 0.36
Outcome – – 0.02
    Cured 305/380 (80%) 494/575 (86%) –
    Death 75/380 (20%) 81/575 (14%) –
1

n/N (%)
2

Pearson’s Chi-squared test; Wilcoxon rank sum test; Fisher’s exact test

CCHF by State, Iraq 2022-2023: cumulative

CCHF by State, Iraq 2022-2023: Interactive maps

Distribution of Ct value by month and year

Ct values and hemorrhagic symptoms

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Ct values by States and Year

Ct values by age group

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